Introduction: The SCCM ICU Liberation Bundle is an evidence-based critical care initiative to improve and optimize ICU patient outcomes, including light sedation goals. Pharmacologic interventions in this bundle include pain, sedation, and delirium. However during the COVID-19 pandemic, study surveys have shown that mechanically ventilated COVID-19 patients had deeper sedation practices which may have affected sedation care in non-COVID-19 patients. The goal of this study is to compare sedation practices in pre- and during the COVID-19 pandemic in non-COVID-19 patients. The results of this study will determine if there was a difference of sedation practices between the two timeframes and if a difference is identified, this may lead to process improvement initiatives.
Methods: This is a retrospective chart review of adult patients admitted to the ICU for at least 24 hours who are mechanically ventilated in February 2020 and August 2021 at three hospitals. Exclusion criteria are patients with a positive COVID-19 diagnosis, therapeutic hypothermia, status epilepticus, patients who are paralyzed, proned patients, undergoing palliative care or withdrawal of life, and on extracorporeal membrane oxygenation (ECMO). Medical charts will be reviewed for relevant demographic, clinical, and laboratory data. The primary outcome is the level of sedation used in non-COVID-19 positive patients before and during the COVID-19 pandemic. Secondary endpoints include hospital length of stay, ICU length of stay, ventilator days, in-hospital mortality, pain scores, CAM-ICU results, and relevant medications.
Results: In the months of February 2020 and August 2022, 625 patients were screened for eligibility and 344 patients were enrolled. Delirium was higher during the COVID pandemic timeframe as seen in CAM-ICU results (p < 0.0001). No differences were seen in baseline characteristics, patient outcomes, remaining ICU bundle, and sedative and pain medications. The duration of propofol was similar while duration of dexmedetomidine was longer in the pre COVID arm (2.60 days vs 1.67 days).
Conclusions: In non-COVID ICU patients before and during the COVID pandemic, no differences in ICU sedation practices and patient outcomes were identified with exception of CAM-ICU results.
